Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. Anyone can get pneumococcal disease, but some people are at greater risk than others such as people 65 years of age and older, the very young, people with certain health problems, people with a weakened immune system and smokers. Pneumococcal disease can lead to serious infections of the lungs (pneumonia), blood (bacteremia) and covering of the brain (meningitis).
 

Pneumococcal vaccine

There are 2 different types of pneumococcal vaccines available in Thailand.

1. Pneumococcal conjugate vaccine (PCV 13) protects against 13 types of pneumococcal bacteria that cause serious disease in most children and half of adults.
2. Pneumococcal polysaccharide vaccine (PPSV 23) protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease in adults.

 

Who should get pneumococcal vaccine?

• All adults 65 years of age and older.
• Children less than 2 years of age.
• Patients who have cerebrospinal fluid leaks.
• Anyone who has a long-term health problem such as heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis.
• Anyone who has a disease or condition that lowers the body’s resistance to infection, such as patients with HIV infection, Leukemia, Lymphoma, long-term immunosuppression therapy or solid organ transplant.
• Any adult who is a smoker or has asthma.

 

How many doses of pneumococcal vaccine are needed, and when?

• Infants and children under 2 years of age: pneumococcal conjugate vaccine is recommended as a series of 3-4 doses depending on the product. The Centers for Disease Control and Prevention (CDC) recommends pneumococcal conjugate vaccine (PCV13) for all infants as a series of 4 doses.

Dose	First dose	Second dose	Third dose	Fourth dose
Age	2 months	4 months	6 months	12 through 15 months

 

• Older children: Healthy children between their 2^nd and 5^th birthdays who have not completed the pneumococcal conjugate vaccine series before age 2 years should get another dose.
• Adults aged 19 years and older:
  • In adults 65 years of age and older, one dose of pneumococcal conjugate vaccine (PCV) followed by one dose of pneumococcal polysaccharide vaccine (PPSV) at least 1 year apart are recommended.
  • Patients who have a greater risk of severe pneumococcal infection, including those with chronic health problems, are recommended to get a pneumococcal vaccine during 19-64 years of age with a booster dose at the age 65 or older. Type of vaccine and schedule may differ depending on health condition in each individual.

What if you cannot get pneumococcal vaccine on time?

Contact your doctor to organize catch-up immunization schedule if miss a dose. Generally, those who miss the second dose and after can resume the schedule without repeat doses. The body still responds to the vaccine and makes antibodies which protect against pneumococcal bacteria.
 

Some people should not get pneumococcal vaccine or should wait.

• Anyone who has had a life-threatening allergic reaction to pneumococcal vaccine, any component of the vaccine, or any vaccine containing diphtheria toxoid (for example, DTaP or diphtheria, tetanus and acellular pertussis) should not get it. Tell your provider if you have any severe allergies.
• Anyone who is moderately or severely ill, with or without fever, when the shot is scheduled may be asked to wait until they recover before getting the vaccine. Someone with a mild illness can usually be vaccinated.

 

What are the risks from pneumococcal vaccine?

• About half of people who get pneumococcal polysaccharide vaccine (PPSV) have mild side effects, such as redness or pain where the shot is given. Less than 1% develops a fever, muscle aches, or more severe local reactions.
• About half of people who got the pneumococcal conjugate vaccine (PCV) experienced drowsiness, had a temporary loss of appetite, or had redness or tenderness where the shot was given. About 1 out of 3 had swelling where the shot was given, and had a mild fever, and about 1 in 20 had a higher fever (over 39 degrees Celsius). Up to about 8 out of 10 became fussy or irritable.

What if there is a severe reaction?

Any unusual condition such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. Call a doctor, or get the person to a doctor right away.
 

Drug Interaction between pneumococcal vaccine and other medications

• Never administer pneumococcal conjugate and polysaccharide vaccines during the same visit.
• A reduced immune response to varicella-zoster virus (VZV) vaccine was observed in individuals who received concurrent administration of pneumococcal polysaccharide vaccine (PPSV) and varicella-zoster virus (VZV) vaccine. Consider administration of the two vaccines separately by at least 4 weeks.
• Pneumococcal polysaccharide vaccine may be given at the same time as influenza vaccine. Consult a doctor for more information regarding a reduced immune response to both vaccines.

 

References

• The Centers for Disease Control and Prevention. Pneumococcal Polysaccharide Vaccine (PPSV23): What You Need to Know. Available from: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html [Accessed 9 June 2022].
• UpToDate. Pneumococcal Vaccination in Adults. Available from: https://www.uptodate.com/contents/pneumococcal-vaccination-in-adults [Accessed 9 June 2022].
• Infectious Disease Association of Thailand. Recommended Adult and Elderly Immunization Schedule. Available from: https://www.idthai.org/Contents/Download/f369b411c5eb95ab252e1ab9de70f787fa720784/1/?p=SMNZ0VJ4 [Accessed 9 June 2021].